ER (1994–2009): Season 9, Episode 22 - Kisangani - full transcript

John Carter arrives in the Congo to find that Luka Kovac is away at a distant clinic administering vaccinations to the local population. He also finds appalling medical conditions. Too few nurses and doctors, limited equipment and few medical supplies are par for the course. That aside, he gets s great deal of satisfaction from the work he does. He meets Gillian, a Canadian nurse, and learns that she and Luka have become close. He tries desperately to save the life of a severely wounded man which pays later dividends when their camp is invaded by rebel troops and their lives are threatened.

Previously on ER:

Trying to travel to Matenda,

but the main road is blocked.

You're going, right--

to Africa?

Est-ce que c'est
la première fois

que vous venez à Kinshasa?

I'm sorry.
I don't speak French.

English?

Long journey.

Yeah, I started
yesterday.



( clearing throat):
Chicago.

Chicago. Michael Jordan

right?

( chuckling )

Yeah. You're going to the Congo
on business?

I'm a doctor.

Where will you stay
in the capital?

I'm not staying
in Kinshasa.

Going on to Kisangani.

Kisangani--
it's in the east.

A doctor in Kisangani.

You will be busy.

Very busy.

MAN:
Dr. Carter?



Dr. Carter?

Dr. Carter.

Dr. Carter.

Hi, I'm John.

Charles Baruani.

You doing good, Dr. John?

I could use a shower.

Next plane is
only three hours.

Not so much nice
as last one.

Many amputees.

Land mines?

Machetes.

Dr. Kovac still here?

Um, he's tall.

He's Croatian.

Lots of black hair, kind of...

Ah,

Luka!

Ah, all the ladies
like Luka very much.

He's still at the clinic
in Matenda.

Very dangerous place.

Mai Mai fight there.

So... we get mostly trauma,

disease, malnutrition?

Yes.

Any one thing
more than the other?

Depends.

On what?

The day.

Welcome to
Kisangani, Doctor.

( generator rumbling )

You must be

Dr. Carter.

Angelique Chada.

I was just coming
to wake you.

I'm the on-site
NGO physician.

You're a medium?

( clearing throat )

You've volunteered
for an NGO before?

Um... no.

Is Dr. Kovac here?

Still in Matenda.

Charles tells me you
don't speak French,

so, I'll get you
someone to translate.

Need a coffee?

Yeah.

Jacques,

apportez un café
au docteur.

Now, it's pretty
simple here.

Fever and a cough
is pneumonia.

Use cotrimoxazole.

Fever and watery
diarrhea is cholera.

Rehydrate and use doxy.

If the patient has a fever
without source,

assume it's malaria
and treat it with fansidar.

If they have
recurrent infections

and are wasting away,
it's AIDS,

so, prepare the family
for death.

What drugs
do you have on hand?

Amoxicillin, doxycycline,

fansidar, metronidazole,
chloramphelicol.

You still use
chloramphelicol?

It's cheap.

What about
the aplastic anemia?

75% of the children here

don't make it to
their second birthday.

Aplastic anemia
is the least of their worries.

For IV antibiotics, we have amp,
gent and penicillin.

Cefoxitin, Unasyn, Cipro?

Nope.

What do you do
for resistant bugs?

Pray.

If you take your meds,
you should be okay.

If you do get a fever,
take some fansidar.

Gillian?

Oui?

Gillian Ronin,
meet Dr. Carter.

Enchanté.

John. Hi.

Gillian's an old hand.

She'll get
you started.

She seems great.

She is.

Where's she from?

Bombay, I think.

She's been here
six years.

How many doctors
are there?

Counting you, four.

Peter is our
Congolese internist,

Deni is from Paris,

Angelique
is our surgeon,

and you
already met Charles.

He handles logistics
and supplies.

We have 200 patients

on six wards, and
two surgical suites.

How many nurses?

Five, but the patients'
family members

do most of the work.

( chuckles )
What?

Well, it's just
the nurses back home

are always complaining
about their patient loads.

It's usually about eight.

Yeah, but I wouldn't
use the conditions here

as a positive
example of anything.

What ward is this?

This is Admitting.

Elle a ete très fatiguée.

Elle a de la fievre et tremble.

Est-ce que
la diarrhee?

Tousse-t'elle?

Non, mais elle est très malade.

Temp's 104.

Mom says
she's got a headache.

No diarrhea or coughing.

Yeah, she's
a little jaundiced, too.

Malaria it is.

Mm-hmm.

So, fansidar?

Yeah, two tablets.

This is going
to fix you right up.

Ces medicaments devraient
l'aider à se sentir mieux.

She doesn't get a bed?

For simple malaria, no.

Bonjour.
Quel est

le probleme?

Saidi ne peux pas uriner.

Il a de la fievre,
une toux et le nez qui coule.

Trouble with
urination, fever
and a cough.

His name's Saidi.

He's about
60 years too young

for an enlarged
prostate.

Bladder's huge.

Yeah.

Full?

Nope.
Manual compression.

Mild fever-- 101.5.

Are there any, uh,
urinary tract infections

that local kids get?

No.

Nous allons
l'aider à uriner

dans
quelques secondes.

( speaking French )

Assiedes-toi.

Non, non, Papa,

laissez le faire.

Essais encore
une fois.

Assiedes-toi.

Okay, tripod sign.

( speaking French )

Okay.

Okay.

Bladder paresis,
tripod and head drop signs.

Uh, I'm sorry...

Poliomyelitis.

Without
a spinal tap,

we use the tripod
and head drop sign

as diagnostic
tools.

He has polio?

Yes.

Très bien, mon cher.

C'est la polio?

Oui.

( anguished sigh )

( Ronin
speaking French )

How's the jet lag?

It's terrible.

Is that
all you're having?

( rueful chuckle )

I've had the food before.

It lacks
a little something.

Taste.

Anyway, I'm on a liquid diet
consumed entirely after dark.

Where are you from?

Your English is excellent.

Montreal.

We speak a little English
up there.

How long have you been here?

Ten days.

I'm a volunteer like you.

Come back for a
month every year.

My penance, I suppose.

Penance for what?

My wanton ways
back in the world.

CHADA:
Hello?

Am I interrupting,
or can anyone just drop in?

You're not interrupting
anything yet.

You two do know

that I'm sitting right here,
right?

She asked how
you're doing,

and I said you were doing great,

and that you'll be
just fine on your
own this afternoon.

So, where
are you from?

Uh, Chicago.

I work
with Dr. Kovac.

He called me
when you got

short-handed.

I'd been thinking
about volunteering.

Luka.

What's he like at home?

Um...

I should get back to work.

A tout a l'heure.

Luka...

took an immunization team
out to Matenda

three days ago.

We don't
get vaccines often,

and when we do,
refrigeration
is a challenge,

so, he grabbed a team
and went.

When do you
expect him back?

Yesterday.

It happens.

BASINAKE:
Mama? Ce fait combien de temps
que Joseph a cette toux?

A peu pres
six jours.

On serait venu
plus top mais

la marche a duree
quatre jours.

( coughing )

He's had fever
for a week.

Ronchi and retractions.

( inhaling )

Tell her that he has pneumonia,

and that we're going
to make him better.

IV ampicillin.

Le docteur est entrain
de l'aider.

Nous allons lui donner
des medicaments

et il devrait aller
mieux tres rapidemment.

Merci, docteur.
Merci.

You're welcome.

Hi.

Who's sick, you or...?

Mon espouse.

Basinake?

Yes, Doctor.

This woman is dead.

Papa?

Le docteur a dit
qu'elle est morte.

I knew.

She has been very ill.

Why didn't you tell us
that she was so sick

when you came in?

She has had AIDS
for many months.

I did not know
where else to go.

Je serais bientot...
a tes cotes, mon amour.

Je t'aime.

Bonjour.

Bonjour.

How is Fazila today?

Comment ca va?

Ca fait mal.

She's in pain,
doctor.

Oh... tell her that I'm sorry
that it's so painful,

but I need her to be brave,
like I know that she is.

Tu dois etre très
courageuse, ma petite...

Okay...

Le docteur a dit que tu
iras mieux bientot,

mais il faut etre fort.

Bonjour, Ntam.

Bonjour.

Oh, great.

Power out
everywhere?

There's only one line

from the turbine
in the river to town.

Mai Mai cut it
every couple of weeks.

How are you
finding it here?

Busy.

But no insurance forms,
no triple charting.

I love that.
No health care system.

Personally, I wouldn't mind

filling out
a few insurance forms

if it meant I could
have an ultrasound.

Charles!
Un denos camions!

Qu'est ce qu'il se passe!

On revenez, on les trouve
sur la route!

KOVAC:
Boy up front
has a gunshot wound

to the left upper
quadrant!

This one is a
machete wound

to the right thigh,
lots of blood loss!

Charles, start the generator!

Lumiere, j'ai besoin
de lumiere!

Where are Peter
and Deni?

Je pense qu'ils sont alles en!

Send someone to find them.

Small-caliber wound
to the belly.

Pulse is 120;
BP: 80/60.

This water's cold!

You want to wait for someone

to boil it again?!

Luka, take the hack wound.
I'll explore the neck.

Dr. Carter, see if
you can discover

what's wrong with this last one.

Where are the gloves?

In the basin.

Right over there.

Un, deux, trois!

That's how we found him.

We got a weak carotid,

and he's tachy.

How do you stabilize
the neck?
Sandbags.

Who's he?

Says that he's the brother.

He wouldn't let us leave
without him.

Give me an ET tube.

We don't have
ET tubes.

I can bag him.

Oh, great.

Ask him what happened.

I don't see
any blood.

He's bleeding
somewhere.

Belly's hard.
Is he Mai Mai?
Yeah.

I got a foreign body
under the skin.

He says that a bee flew
into his brother,

and his brother fell down.

Femur deformity,
closed fracture.

What?

A bee flew into him.

A bee?

( buzzing )

We got a single entrance wound
to the right axle.

Bag him on 15 liters.
Make it two liters,

or we'll run
out of oxygen.

BP est a cent huit
sur soixante douze,

le pou est de quatre
vingt quatorze.

I've got a GSW
to the right axilla,

bullet ended up
in the thigh.

An hour isn't
enough time!

Unplug every light
in the hospital.

How much time
will that get us?

Four hours, maybe.

BP's 90/60.

Pulse: 130,
pulseless foot.

Get his pressure up
with two liters.

I'll be right back.

He's got a trans-thoracic GSW.

Bullet entered the
armpit, dropped a lung,

transversed
across the belly,

and ended up
in the thigh

with enough force
to break the femur.

Abdomen's stiff, Betadine.

Going to need a chest tube,
maybe two.

Got peritoneal signs.

Positive DPL.

Where's the bullet?

To the left anterior thigh,

but you don't need
a DPL; he meets
surgical criteria;

he needs an E lap.

Knife.

He's Red Cross category four.
Waste of resources.

Hand me that.

There. The least of his
problems is solved.

Full-jacketed
7.62-millimeter

with four rifling grooves--
a Dragunov rifle.

His pressure's
holding.

Dragunov's muzzle velocity
is 830 meters per second.

It can kill from over
a half mile away.

Closer, it does even more
internal damage.

So we're just going
to let him die?

If I take him first,
he's going to take

at least five hours
to stabilize,

and then he'll probably
die anyway.

I have four hours
of generator fuel left,

and three boys
with injuries I can fix

before the power goes out.

Keep him stabilized.

If the lights are still on when
I'm finished with the others,

I'll come back.

( patient breathing heavily )

Have you ever done
an end-to-end
anastamosis?

No.

Well, now's as good
a time as any

to start your training
as a vascular surgeon.

Anchor it with a
simple overhand...

How much longer?

( sighs ):
I don't know.

Still working
on the last one.

We need more blood.
That's the second unit.

I'm O-Negative.

I could donate.

You can't save the world.

Is that why you're here,
working at the Ritz?

( chuckles ):
Me? I'm in it for the money.

Thought we had another hour.

It's the roll.

What?

The roll.

They roll
the generator fuel tank

when it gets near the bottom

so they can squeeze out
every last drop.

Makes the lights flicker.

Last of the 6-O
prolene.

Unclamping the
femoral artery.

Got a pulse in the foot.

Good. Pack it
and leave it open.

He still alive?

Yeah, barely.
Prolonged hypertension.

Could be ischemic.

How much time do
we have left?

Uh, half an hour or so.

Charles...

Okay, let's see
what we can do.

Release pressure.

No bleeding.

All right, let's pack in there

with some more lap pads,
come on.

We're out of lap pads.

They've got another
five minutes

in the sterilizer.

( grunting )

Here.

I'm losing track. What else?

Uh, liver, spleen,
removed a wedge of lung,

repaired the renal vein.

Still have
the diaphragmatic repair,

and then we have
to run the bowel.

Run of V-tach.

100 lidocaine.
Start a drip.

Two milligrams
per minute.

Duodenal hematoma.
Stapler.

You're going to staple
the duodenum?

Faster than sutures.

Okay, drip is 100 in 500
at ten drops per minute.

Okay, I'm going to run the bowel

while you do
the diaphragm.

Oh, that's it?

CHARLES:
Je viens, je viens!

ANGELIQUE:
We're out of time.

We'll have
to leave him open.

If he survives the night,
we can come back

in the morning
and repair the bowel.

There's still fecal
matter in here.

It'll have to do.

Pack it. Then tape.
Lots of tape.

He's oozing
from his fingertips.

( pan clanking )

This is DIC?

Blood around the gums, too.

Are those clean
lap pads done?

I can't get a pulse. Irregular.

Come on.

Lost it.

All right. I'm pulling the tape.

Dr. Carter...

( inhaling )

I can't find the heart.

All right.
There it is.

I got it, I got it.
Starting compressions.

No pulse,
no pressure,

no resps.

He just needs more volume.

( exhales )

Leave him be.

Let him be, Doctor.

( sighs )

( sighing )

Tell him I'm sorry.

He knows.

( chair squeaking )

I didn't know you smoked.

Ah... I don't.

When did you get here?

Six days ago.

( sighs )

How much longer
are you staying?

I don't know.

I'm going back to
the clinic tomorrow.

I have patients there
who can't be moved.

I came back for
some supplies.

Welcome back.

Thank you.

I thought you
might be upset.

About that boy.

I'm okay.

I'm exhausted.

I'm going to bed

and, um...

I hope someone will join me.

How's Abby?

I didn't do anything
with Gillian, I swear.

So you won't mind if I...

No.

Knock yourself out.

I'll see you
in the morning.

She took the pills you gave her,
but the fever came back, Doctor.

Yeah, the fansidar
isn't working.

Her malaria's advanced.

IV quinine, uh, ten per kilo

every eight hours.

Le docteur lui donnera des
medicaments plus forts.

ANGELIQUE:
John?

Meet Doctors
Thorpe and O'Brien.

Americans.
Fresh off the plane.

Damn, it's hot.

Actually, we got
a little bit

of a breeze
blowing today.

Gillian?
Yes.

Would you
finish the tour,

get them started
down in triage?

Sure.
Welcome.

What are you
doing tomorrow?

Is that
a trick question?

Charles brought vaccine in
on the plane from Kinshasa.

Road's open,
but who knows for how long.

Thought you might want to put
together an immunization team.

See a bit
of the country.

Yeah, where would
we be going?
Matenda.

but you'll have to find a nurse
who's willing to go with you.

...and work in admitting.

CARTER:
Who are they?

Interahamwe, Hunde,
Banyarawanda.

Hard to tell anymore.

Everyone fights
everyone else now.

FAC.

Government's army.

PATRIQUE:
I grew up
near here.

Everyone very happy.

It was beautiful.

I wish you could
have seen it then.

Good trip?

Slow.

What'd you bring?

Polio, DPT, MMR.

Supplies.

What are all those people
waiting for?

You.

( girl sobbing )

How do you say
"Don't be afraid?"

Well, something like that.

N'aie pass por mon pissin.

( laughs )

She's laughing at me.

Your French is terrible.

See?
Didn't even hurt.

Au revoir.

Bonjour.

Bonjour.

( coughing )

( wheezing )

Gillian.

Ask him how long

his son has had this cough.

GILLIAN:
Papa, ca fait
combien de

temps que ton fils tousses?

Ca fait quelques semains.

Il n'arrete pas de tousser.

About two weeks.

Do we have any erythromycin?

Only amoxicillin and ampicillin.

Pertussis?

Yeah.

Tell him that his son is sick

and we're going to give him

some medicine to try
and make him feel better.

GILLIAN:
Papa, il
faut donner

des medicament a ton fils
pour son toux.

Il devrais se sentir mieux.

Merci, madame.

GILLIAN:
Charles?
CHARLES:
Oui?

Monsieur?

Oui?
( coughs )

Bonjour.

( gunfire )

That sounds close.

Yeah, a mile,
maybe two.

Pertussis.

We don't have anything
stronger than amoxicillin.

Did you tell that boy's
father we could save him?

We can.

Whooping cough's

going to eat that
amoxicillin for lunch.

He's going to die.

Die from a disease
that we could wipe out

with a ten-dollar course
of erythromycin.

We vaccinated
200 children today.

When was the last time you saved
200 lives in one afternoon?

( explosions approaching )

( country music playing )

Would you like a drink?

Willie Nelson?

Charles went to college
in Texas.

CHARLES:
Dr. John!

Get down!

Get down!

( child shrieking )

Luka!

Foot's missing above the ankle.

Get a BP cuff!

On se cacher
dans notre maison

quand on a entendu
une explosion terrible,

tres proche.
( girl screams )

Et puis elle n'arretais
pas dee crier.

Lumiere, j'ai besson
de lumiere!

( girl screeches )
Foot's gone.

We're going to operate
below the knee.

Is there any
surgical equipment here?

No.

What about anesthesia?
Ketamine?

Only lidocaine.

Okay.

We need to do a Bier block
with lido. Gillian!

Yes?
Start an IV
in the popliteal.

( girl screeches )

KOVAC:
Somebody please get

this poor girl's mother
away from here.

Charles, get a suture kit

and the biggest kitchen knife
you can, and a saw.

We're going
to need to sterilize
some sort of saw.

What's her name?
Chance.

Chance...

( girl screaming )

GILLIAN:
She's unconscious.

Okay, skin's good
below the knee.

Tie off the bleeders.

I need
the flashlight closer!

They're fighting!

They're coming this way!

We need to evacuate
the patients!

Evacuate them where?

To the old plantation.

KOVAC:
Go, go!

Il faut evacuer
toute le monde!

KOVAC:
There's
another bleeder.

CARTER:
I got it.

Got that one?

We should go.
Not yet.

They're getting too close.

KOVAC:
Got that one?

Luka, we have to leave her.

No!
CHARLES:
She's right!
We must go!

Saw, Charles,
what do we have for a saw?

CARTER:
Betadine.

Okay, hold it steady.

Okay, I'm through.

Moist dressing!

( gunfire )

KOVAC:
Okay, let's go!

( bird singing )

How's her pulse?

Strong.

Regular.

If there's
no infection
in four days,

I'll revise it
and clean up the flap.

The skin looked good.

Should make a
nice seat for
a prosthetic.

Yeah, that was impressive.

Looked like you did it before.

I have.

In the beginning,
there's always a lot

of talk of national pride
and patriotic speeches,

but after a few weeks,
it becomes this.

Nothing but death
and sadness.

These people just want
what everyone else wants.

Their kids to have
something to eat.

To see them grow up
laughing, happy.

They-they don't care
where the border is

or who gets
to call themselves President.

They just want
this to stop.

Oh, I don't even begin to try
to understand the politics here.

You are an American, Carter.

You... believe if people
are given the chance

to convert to democracy,

the world would be
a better place.

What's the alternative?

Military dictatorships?

You fight wars from the sky
with bombs and missiles,

and then your planes land back
on the aircraft carrier,

and the pilots
watch Drew Carey

on satellite TV.

Hey, American soldiers died
in Iraq.

Yeah, but your children
don't starve to death

while your men fight.

Your women aren't raped.

( wind blowing )

I remember...

watching the television,
reading the newspapers...

certain that we had to fight.

And then my family was gone.

I couldn't remember why
it was all so important.

And what difference
did it all make?

My children were dead.

PATRIQUE:
Hey, here.

One is still alive.

Bring him in.

The food's gone,
some supplies.

Where do you want him?

Right here.

Gillian,

we need another
IV ampicillin
and whatever

we have
for pain.

Okay.

FAC.

A government
soldier.

Carter?

Small-caliber GSW
to the right upper thigh.

He's pale and diaphoretic.

Lost a lot of blood.

( coughing )

He's not really
improving.

Do you want to
try penicillin?

No. Stay with the amp.

No sign of infection.

Yeah, that looks good.

MAN:
Docteur?

Docteur?

Laissez-moi, laissez-moi.

What's his problem?
He wants to get
back to the Army.

He's afraid to stay here.

Laissez-moi.
Je dois partir, monsieur.

Je dois partir.

Does he know
where the Army is?

I don't think so.

Laissez-moi.

Je dois partir.

Tell him, uh...

as soon as he can walk,
he's free to go.

I have patients who
can't be transported.

It's too dangerous.

The fighting's heading back
this way.

Angelique wants
to abandon the clinic

until it's safer.

The road's open again?

We think so.

A UN food truck got through
this morning.

If we move them,
they'll die.

How many?
At least three.

Take everyone else,
leave me some supplies,

and get back for
me in a few days.

No, I can't.
I won't leave
my patients.

I'll try to reach Angelique
on the radio.

I can stay,
Dr. Luka.

You want to stay, too?

No.
I will.

No, please.
Just take Gillian.

Make sure she
gets back safely.

What was that all about?

The road's open.

GILLIAN:
You'll need help.

KOVAC:
Patrique is staying.

He has no medical training,
and you cannot take care

of three critical
ill patients by yourself.

Of course I can.

Oh, yeah?

And how are you supposed
to do a Bier block

on that open amputation
without a nurse to assist?

You're not staying.

It's not your decision.

You are getting
to that truck

with Carter
and going.

No, I'm not.

Hey, it's only for
a couple of days,

then you'll come
back and get us.

Is it Mai Mai?

Qui etes vous, vous allez ou?

CHARLES:
Nous sommes
des travailleurs

medicaux de WMG,

on transport
des personnes

injuriées a l'hôpital
en Kisangani.

Qui sont ces gens?

On vient de World
Medical Group,

nous sommes tous
medecins et infirmiers.

On est medecins,
on est neutre.

Vous ne devrais pas etre ici.

C'est le territoire de Mai Mai.

Vous n'appartenez pas ici.
On devrais vous tuer.

Justement, partais.

On est medecins,
on est tous medicins.

BOY:
Byanmungo,

un soldat,
un soldat.

Je vous en prie.

Docteur?

Docteur, aidez-moi,
s'il vous plaît.

Je vous en prie,
Docteur.

Aidez-moi.

( speaking French )

Docteur, aidez-moi,
s'il vous plaît.

( both speaking French )

Vous occupez des soldats
du gouvernement?

Je vous en prie.

Nous aidons tous les gens
qui ont besoin d'aide.

Nous sommes neutre.

Nous nous occupons
tout le monde.

Nous, tout le monde.

Silence!

...mon intelligence.

( speaking French )

Vous travaillez
pour le gouvernement.

( speaking French )

...Je vous en prie.

( speaking French )

Je vous en prie.

...Je vous en prie.

Laissez-moi.

Byanmungo, c'est les medecins

qui attend de sauver
la vie de mon frère.

C'est les medecins dont
je t'ai parler qui attend

de sauver la vie de Leon
pendant si longtemps.

Qui lui?
Oui.

What's he saying?

That you tried
to save his brother.

That you tried
for a long time.

Hello.

Hi.

...de travailleur pour les
soldats le gouvernement...

...tout le monde!

Raphael, viens maintenant.

Merci.

You're welcome.

( gunshot and scream )

( gunshot )

( breathing shallowly )

So, what should I tell Weaver?

Whatever you want.

Can I tell her
you're coming back?

I don't know.

Don't do anything stupid now.

Like what?

Like get yourself killed.

( engine starts )

Oui.

Elle est mon trésor.

( door creaking shut )